title: Impact of vendor computerized physician order entry on patients with renal impairment in community hospitals.
abstract: BACKGROUND
  Adverse drug events (ADEs) are common among hospitalized patients with renal impairment.
  
  
  OBJECTIVE
  To determine whether computerized physician order entry (CPOE) systems with clinical decision support capabilities reduce the frequency of renally related ADEs in hospitals.
  
  
  METHODS
  Quasi-experimental study of 1590 adult patients with renal impairment who were admitted to 5 community hospitals in Massachusetts from January 2005 to September 2010, preimplementation and postimplementation of CPOE.
  
  
  METHODS
  Varying levels of clinical decision support, ranging from basic CPOE only (sites 4 and 5), rudimentary clinical decision support (sites 1 and 2), and advanced clinical decision support (site 3).
  
  
  METHODS
  Primary outcome was the rate of preventable ADEs from nephrotoxic and/or renally cleared medications. Similarly, secondary outcomes were the rates of overall ADEs and potential ADEs.
  
  
  RESULTS
  There was a 45% decrease in the rate of preventable ADEs following implementation (8.0/100 vs 4.4/100 admissions; P < 0.01), and the impact was related to the level of decision support. Basic CPOE was not associated with any significant benefit (4.6/100 vs 4.3/100 admissions; P = 0.87). There was a nonsignificant decrease in preventable ADEs with rudimentary clinical decision support (9.1/100 vs 6.4/100 admissions; P = 0.22). However, substantial reduction was seen with advanced clinical decision support (12.4/100 vs 0/100 admissions; P = 0.01). Despite these benefits, a significant increase in potential ADEs was found for all systems (55.5/100 vs 136.8/100 admissions; P < 0.01).
  
  
  CONCLUSIONS
  Vendor-developed CPOE with advanced clinical decision support can reduce the occurrence of preventable ADEs but may be associated with an increase in potential ADEs.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Leung
authors.forename: Gordon
authors.initials: G
authors.lastname: Schiff
authors.forename: Carol
authors.initials: C
authors.lastname: Keohane
authors.forename: Mary
authors.initials: M
authors.lastname: Amato
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: Bismarck
authors.initials: B
authors.lastname: Cadet
authors.forename: Michael
authors.initials: M
authors.lastname: Coffey
authors.forename: Nathan
authors.initials: N
authors.lastname: Kaufman
authors.forename: Eyal
authors.initials: E
authors.lastname: Zimlichman
authors.forename: Diane L
authors.initials: DL
authors.lastname: Seger
authors.forename: Catherine
authors.initials: C
authors.lastname: Yoon
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006764:Hospitals, Community / Q000592:standards* / Q000639:trends; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects; D051437:Renal Insufficiency / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics